| NPI | 1932533445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 7013011-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-02222) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2023-04-13 |